Provider Demographics
NPI:1700225752
Name:HASSANZADEH, MEHRAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEHRAN
Middle Name:
Last Name:HASSANZADEH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 MINNA ST APT 1110
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4692
Mailing Address - Country:US
Mailing Address - Phone:404-308-1440
Mailing Address - Fax:
Practice Address - Street 1:3332 N TEXAS ST STE C
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-9806
Practice Address - Country:US
Practice Address - Phone:707-399-9082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014612122300000X, 1223X0400X
CA1072591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist